Emergency care can be defined as the episodic and crisis-oriented care provided to patients with serious or potentially life-threatening injuries or illnesses
Initial Assessment: Form a general impression of the patient
Assess the Patient's Mental Status:
Classify the patient's mental status into one of the following categories:
The primary survey: Mnemonic ABCD
· Does the patient have an open airway?
· Is the patient able to speak?
· Check for airway obstructions such as loose teeth, foreign objects, bleeding, vomits or other secretions.
· Treat immediately
· Is the patient breathing?
· Assess for equal rise and fall of the chest
· Respiratory rate and pattern
· Skin color
· Use of accessory muscles
· Integrity of the chest wall
· position of the trachea.
· Palpate a central pulse?
· What is the quality (strong, weak, slow, rapid)?
· Is the skin warm and dry?
· Is the skin color normal?
· Obtain a blood pressure
· Assess level of consciousness and pupils
· Assess level of by GCS scale:
· Is the patient alert?
· Does the patient respond to voice?
· Does the patient respond to painful stimulus?
· The patient is unresponsive even to painful stimulus.
Secondary Assessment: Mnemonic:"EFG"
Head, neck, Chest, Abdomen
Examine for any injuries
Environmental control: prevent heat loss by using warm blankets, overhead warmers, and warmed I.V. fluids
Full set of vital signs
· Obtain a full set of vital signs
· obtain blood pressure in both arms if chest trauma is suspected.
· cardiac monitoring
· pulse oximetry to measure the oxygen saturation
· Indwelling urinary catheter
· gastric tube
· Laboratory studies
Ø Blood group and cross matching
Ø hemoglobin and hematocrit
Ø urine drug screen
Ø blood alcohol,
Ø prothrombin time (PT) and partial thromboplastin time
Ø pregnancy test if applicable
Facilitate family presence
If any member of the family wishes to be present-during-the-resuscitatjon, it is imperative to assign a staff member to that person to explain what is being done and offer support
Give comfort measures: verbal reassurances as well as pain management.
Focused History & Physical Exam - Trauma
· Re-evaluate Mechanism of Injury (MOI)
· Significant MOI? Yes/No
o Is patient unresponsive or disoriented?
· Is patient under the influence of drugs or alcohol?
· Patients with Significant MOI
RAPID TRAUMA ASSESSMENT
· D - Deformities
· C - Contusions
· A - Abrasions
· P - Punctures/Penetrations
· B - Burns
· T - Tenderness
· L - Lacerations
· S -Swelling
Quickly Obtain Baseline Vital Signs
S - Signs & Symptoms
A – Allergies: Medications, Foods, Environment
M - Medications
· Are you taking any?
· When did you last take your medication?
· What are they?
· What are they for?
· May I see them?
P - Previous Medical History
· Related to this complaint
· Complicating factor
L - Last Oral Intake Food and/or Drink?
E - Events leading up to the incident
· What happened?
Head-to-Toe Assessment patient's general appearance, including body position or any guarding or posturing.
Head and face
· Inspect for any lacerations, abrasions, contusions, puncture wounds, ecchymosis, edema Palpate for crepitus, crackling, or bony deformities.
· Inspect for breathing effectiveness, paradoxical chest wall movement, disruptions in chest wall integrity.
· Auscultate for bilateral breath sounds and heart sounds
· Palpate for bony crepitus or deformities
· Inspect for lacerations, abrasions, contusions, puncture wounds, ecchymosis, edema, scars or distention.
· Auscultate for the presence of bowel sounds.
· Palpate for rigidity, guarding, masses, or areas of tenderness Pelvis/perineum
· Inspect for lacerations, abrasions, contusions, puncture wounds, ecchymosis, edema, or scars
· Look for blood at the urinary meatus.
· Palpate for pelvic instability and anal sphincter tone
· Inspect skin colour and temperature.
· Look for signs of injury and bleeding.
· Does the patient have movement and sensation of all extremities?
· Palpate peripheral pulses
· Bony crepitus Areas of tenderness
· Posterior surfaces
· Inspect for possible injuries-
· Palpate the vertebral column and all tenderness
Any injuries that were identified during the primary and secondary sunseys require a detailed assessment.
Approach to the Patient
· Understand and accept the basic anxieties of the acutely traumatized patient.
· Understand and support the patient's feelings concerning loss of control.
· Treat the unconscious patient as if conscious.
· Avoid making negative comments about the patient's condition. Be prepared to handle all aspects of acute trauma know what to expect and what to do.
Approach to the Family
· Inform about patient admission unit
· Give as much information about the treatment.
· Allowing a family member to be present during the resuscitation.
· Recognize the anxiety of the family
· Acknowledge expressions of anger, guilt, and criticism. Deal with reality as gently and quickly as possible Avoid encouraging and supporting denial.